title: Endoscopic ultrasonography-guided cholecystogastrostomy in patients with unresectable pancreatic cancer using anti-migratory metal stents: a new approach.
abstract: Cholecystectomy is contraindicated in patients with comorbidities or unresectable cancer. Percutaneous transhepatic gallbladder drainage (PTGBD) is typically offered with response rates ranging from 56% to 100%, but has several risks such as bleeding, pneumothorax, pneumoperitoneum, bile leak, and/or catheter migration. Endoscopic transpapillary gallbladder drainage (ETGD) and endoscopic ultrasound-guided transmural gallbladder drainage (EUS-GBD) are alternative endoscopic modalities that have a technical feasibility, efficacy and safety profile comparable with PTGBD. In this report, we present the first case series of transgastric EUS-GBD with placement of a fully covered self-expandable metal stent with anti-migratory fins. In three pancreatic cancer cases with acute cholecystitis when ETGD was unsuccessful, there were no bile leaks or procedurally related complications. There were no acute cholecystitis recurrences. In conclusion, EUS-GBD is a promising, minimally invasive treatment for acute cholecystitis. Additional comparative studies are needed to validate the benefit of this technique.
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Widmer
authors.forename: Paloma
authors.initials: P
authors.lastname: Alvarez
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.forename: Naveen
authors.initials: N
authors.lastname: Paddu
authors.forename: Hiren
authors.initials: H
authors.lastname: Umrania
authors.forename: Reem
authors.initials: R
authors.lastname: Sharaiha
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000628:therapy*; D004322:Drainage / Q000379:methods; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D015607:Stents
chemical_list: D008670:Metals
keywords: endoscopic ultrasonography (EUS); fully covered metal stent with anti-migratory fins (FCSEMS-AF); gallbladder drainage (GBD); pancreatic cancer; transgastric GBD